Family planning

1. By,
Lutfi Abdallah

2. • FP Refers to voluntary decision and action taken by a
couple or individual to delay, space or limit child bearing
• Family planning means deciding how many children to
have and when to have them. Birth control is a
cornerstone of the concept.
• FP services are provided to all adults who voluntarily
seek the services regardless of the parity or marital
status.

3. • The family planning services offered by the National
Family Planning Program include;
 Education and counseling.
The provision of contraceptives.
 Education about sex and parenthood.
 Management of infertility

4. • The population size of TZ has almost tripled from 12.3mil in
1967 to 34.4mil in 2002 while the national economy did not
grow significantly.
• With an annual growth rate of 2.9%, Tanzania’s population
has been projected at 65 million by 2025. Based on the
fact that all of the girls who will enter childbearing age over
the next decade have already been born, and the fact that
almost 50% of the country’s population are under 15 years,
Tanzania’s population growth is set to remain at 2.8% by
2025, according to the National Bureau of Statistics (NBS)
national projections.
• Therefore it became evident that improvement in the
quality and expansion of services such as health and
education is unlikely to happen without controlling rapid
population growth

5. • High fertility levels are partly attributable to early initiation
of childbearing coupled with socio-cultural practices that
place emphasis on big families, hence contributing to
rapid population growth. 26% of mothers are teenage
(15-19) in Tanzania.
• High Maternal Mortality Rate due to illegal
abortion, frequent pregnancies, high parity, and women
having children at ages recognized as high risk.
• High infant and child mortality rate

6. • Achievement:
The total fertility rate (TFR) has slightly decreased from an
average of 5.6 children per woman of reproductive age (15-
49) in 2007/08 to an average of 5.4 children per woman of
reproductive age in 2009/10
• Challenge:
Factors contributing to high fertility still pertain and
continued advocacy efforts are needed to sustain an
enabling environment necessary for reduction in TFR.
The impact is especially significant in the peripheral areas
where health facilities are poorly equipped.

7. • Achievement:
There is a drop in the high rate of maternal deaths of 578
per every 100,000 live births in 2004-5 to 454 per every
100,000 live births 2010.
• Challenge:
According to a United Nations Report released in
September 2010, Tanzania is among countries in the world
that still have high rates of maternal death despite falling
rates of maternal mortality at the global level.

8. • Achievement:
Good progress has been made in reducing the infant and
under-five mortality rate from 58 and 91 deaths of infants
per 1,000 live births in 2007/08 to 51 and 81 deaths per
1,000 live births, respectively, according to the 2010 TDHS.
• Challenge:
UN Report placed Tanzania as the third country with the
largest number of death of children in Africa after Nigeria
and Democratic Republic of Congo.

9. • Achievement
According to the DHS, 34% of married women are currently
using a method of contraception (traditional and modern)
compared to 26% of married women that were using any method
in 2004/05. The survey showed that the number of married
women that were using modern methods of contraception (i.e.,
oral contraceptive pills, contraceptive injectables, IUDs, implants,
sterilization and condoms) has continued to increase from only
20% of the married women in 2004/05 to 27.4% in 2009/10.
Challenge:
About 22% of married women in Tanzania who want to prevent
or delay a pregnancy and use contraception do not have access
to a method because of weak infrastructure, electricity and
space of storage
Socio-cultural barrier: gender inequalities, low women
empowerment and misconceptions of various health related
issues exist.

10. 1. Some service providers’ attitudes towards FP are poor and they lack motivation to
reach out to clients with accurate information.
2. Low public awareness of reproductive health matters such as management of
pregnancy, newborn care, childcare and related complications. For example, some
clients associate condom use with extra-marital sex and vasectomy as castration.
3. Advocacy to improve public knowledge on FP towards overcoming the negative
perceptions in some of the FP methods is greatly needed.
There are numerous reasons that are attributable to the situation of reproductive health
commodities being insufficient. One is that of funding. Donor support in the
commodities dropped from $560 million in 1995 to $460 million in 2003.
The Global Programme to Enhance Reproductive Health Commodity Security reveals
the same trend between 2007 and 2013, the amount needed was $750,000,000 only
$208,528,277 was receives while $170,041,267 was pledged and still $371,430,456
was needed.
4. Inconsistent and ineffective FP messages, limited support by indigenous
organizations to advocate for FP, and inadequate skilled personnel especially for Intra-
Uterine Device (IUD) and implants.

11. • Family planning helps women to stay healthy and
improves the outcomes of their pregnancies.
• Family planning can improve the economic position of
families and communities and preserve natural
resources.
• Prevent too-close spacing of pregnancy which increases
the risk of miscarriage and premature births

12. • The government’s dedication to promote FP over the past several
decades dates back to the 1970s.
• In 1974, the government acknowledged the role of the Family
Planning Association of Tanzania (UMATI) established in 1959,
and allowed it to expand FP services to public sector maternal
and child health (MCH) clinics throughout the country.
• Several national policy documents have been developed
targeting improvement of reproductive and child health services,
which include maternal and newborn health.
• Apart from ensuring that FP was integrated into maternal and
child health services in the 1980s and 90s, the government put in
place a number of policies, guidelines and frameworks to ensure
that FP become integral to socio-economic development.
• Government had to revise the National Population Policy in order
to accommodate those new developments, in 2006 the Revised
National Population Policy was published.
• The main goal was to Coordinate and Influence other policies,
strategies and programs that ensure sustainable development of
the people and promoting gender equality and the empowerment
of women.

13. These policies include:
• The National Health Policy (2007);
• National Road Map Strategic Plan to Accelerate
Reduction of Maternal and Newborn & child deaths in
Tanzania (2008-15);
• Health Sector Strategic Plan III (2009-2015);
• Primary Health Services Development Programme
(2007-2017);
• National FP Costed Implementation Plan (2010-2015);
• National Strategy for Growth and Poverty Reduction
(NSGPR).

14. • With specific reference to FP, the goals of the policy
were:
• To strengthen family planning services to promote the
health and welfare of the family, community and the
nation and eventually to reduce pop growth rate.
• Making FP services available to all who want them.
• Encourage every family to space births at least two years
apart.

15. • The above situation calls for intensified efforts to
promote family planning as part of
comprehensive health strategy in TZ in order to:
Avoid pregnancies before 18yrs and above 35yrs.
Promote women health and family health at large by promoting
child spacing.
Reduce unwanted pregnancies and hence abortions.
Finally reduce the Maternal Mortality and Morbidity.

18. A. Reversible Method
- Natural Method.
- Barrier Methods.
- Intrauterine contraceptive devices.
- Hormonal Methods.
B. Non Reversible Methods
- Bilateral Tubal Ligation.
- Vasectomy.

19. • Natural family planning involves trying to determine when
ovulation will occur and timing sexual intercourse to
either achieve or avoid pregnancy.
• Couples keep a chart to monitor changes in the woman's
body(rising body temperature or thickening of the cervical
mucous, both of which suggest ovulation).

20. • This is an extremely important method of
contraception worldwide and may be the
only one acceptable to some couples
because of cultural and religious reasons.
• As birth control, natural family planning can be 90 to 98
percent effective.

21. • Coitus interruptus
-Also called withdrawal, involves removal
of the penis from the vagina immediately
before ejaculation takes place.
-It is not reliable as pre-ejaculatory
secretions may contain millions of sperm
and also it is hard to judge timing of
withdrawal.

22. • The failure rates of natural methods are quite
high, largely because couples find it difficult to abstain
from intercourse when required or unable to withdraw the
penis before seminal discharge.

23. • Male Condoms
•Have been heavily promoted in the Safe
Sex campaign to prevent spread of STD
particularly HIV/AIDS.
•They are cheap and widely available to
purchase or are even free from many
clinics

24. •When used properly they can be 95%-
100% effective against unwanted
pregnancies.
•Some men and women may be allergic to
latex condoms but these days plastic
condoms are available.

25. • Female Condom
•Made of plastic, they are also available.
•They offer particularly good protection
against infection.
•Many couples find them unaesthetic and
they have not achieved widespread
popularity

26. • Diaphragm
•Are inserted into the vagina and cover
the cervix.
•Should be inserted prior to intercourse
and should be removed no earlier than
six hrs later.
•Effective use of diaphragm involves
careful fitting and teaching.
•Can be used with a spermicidal gel or
cream.

27. • Combined Oral Contraceptive Pills (COC)
• Contains a combination of two hormones, synthetic oestrogen and
progesterone.
• They inhibit ovulation.
• Easy to use and offers a very high degree of protection against
pregnancy with many other beneficial effects.
• It is used mainly by young, healthy women.
• They are absolutely Contra Indicated to pts with Circulatory
diseases, acute or severe liver diseases, oestrogen-dependent
neoplasm e.g.breast cancer.
• Side effects include irregular bleeding, vaginal discharge, breast
pain, weight gain, nausea and vomiting, headaches, depression

28. • Progestogen only pills (POP)
• Ideal for women who like the convenience of the pill but cannot
take COC.
• Particular indications for POP include breastfeeding, older women,
presence of cardiovascular risk factors and diabetes

29. • Injectable progestogen
• Also known as Depo Provera, each injection lasts around 12-13
weeks.
• It is highly effective and it is given by deep IM injection.
• Its particularly good for those with difficulty in remembering to take
a pill.
• Side effects include weight gain, delay in return of fertility,
persistent menstrual irregularity

30. • Sub-dermal implants
• Norplant consist of 6 silastic rods which contain
levonogestrel. They are inserted subdermally in the
upper arm.
• Release levonogestrel slowly and lasts for five years.
• They are very effective.
• Insertion and removal of Norplant must be done by a
trained healthcare professional i.e client cannot start or
stop use on her own.
• Common SE include changes in menstrual
bleeding, headaches, dizziness,nausea, nervousness,
acne or skin rash, weight gain.
• Implanon, single silastic rod, 3yrs.

31. • They are highly effective but not widely used in our setup.
• Fitting of an IUD should be carried out by trained
healthcare personnel only.
• Ideal for women who want a long-term method of
contraception independent of intercourse and where
regular compliance is not required.

32. • Types:
•Plastic IUD e.g. LIppes loop
•Copper-bearing IUD e.g. copper T
•Hormonal releasing IUD e.g. progestogen
releasing IUD.

33. • They are long-lasting, 5-10yrs.
• Common side effects include menstrual changes in the
first 3 months.
• Others, like PID is more likely to follow STD infection, or
the IUD may come out of uterus without the woman’s
awareness.

34. The following indicators summarizes the
most useful pieces of information available
from large scale survey for measuring
contraceptive practice.

35. • Contraceptive Prevalence Rate (CPR)
• Proportion of women of reproductive age who are using
(or whose partner is using) a contraceptive method at
particular point in time.
• The CPR provides a measure of pop coverage of
contraceptive use, taking into account all sources of
supply and all contraceptive methods.
• It is the most widely reported measure of outcome for
family planning program at a population level.
• Currently in TZ the contraceptive prevalence is 25%.

36. • Number of Current Users
• The number of women (or their partners) of
reproductive age who are estimated to be using a
contraceptive method at a given point in time.
• Number of current users provide a summary measure
of total program service volume.
• But counting number of current users from program
has proven to be labour intensive and time consuming.
• Also most researchers and evaluators are more
interested in CPR

37. • Level of Past Use.
• The proportion of women of reproductive age who have
ever used a contraceptive method, include those who
currently use one.
• Provides a crude measure of the extent to which a
given population has experimented with methods of
contraception i.e that they have first hand knowledge
by having tried it at some point in time.
• In TZ 41% of women aged 15-49 and 48% of all men
have used a contraceptive method at some point in
their lives (1999).

38. • Source of Supply (By Method)
• The % distribution of the types of service delivery points cited by
users as the source of their contraceptive method.
• Useful in family planning programme officials to show where
contraceptive users obtain their supply, for both evaluating
program effectiveness and forecasting procurement needs
• In Tanzania, current users (modern) are more likely to obtain their
supply from the public sector (67%) than the private medical
sector (22%) or other private source (11%).
• i.e. public sector is the source of modern contraceptives to 7 of
every 10 current users

39. • Method Mix
• Percentage distribution of contraceptive users by
method.
• It indicates the distribution of contraceptive use across
different methods of contraception.
• It can reflect provider bias, supply problems and client
preferences.
• Essential in forecasting of commodity and service
needs in future.
• In TZ, the most widely used methods are injectables
(5%),the pill (5%), and male condom (4%) – 1999.
From TDHS 2004-05, Injectables (8%), the pill (6%)
and traditional method (6%).

40. • Contraceptive use has substantially increased over the
past 15yrs. In 1991-92 only 10% of all women were using
any contraceptive method; that proportion has more than
doubled to 25%.
• On the other hand, in 1991-92, the use of any modern
contraceptive method among all women was at 6%, and
the % has almost tripled to 16% in 1999.
• On specific method most notable is the steady rise in use
of injectables, from less than 1% in 1991-92 to 5% in
1999 to 8% in 2004/05.

41. • In spite of the sizeable proportion of women who say that
they do not want to have any more children, the
proportion of women who have been sterilized has
changed little.
• Current use of traditional methods has increased from
about 4% in 1991-92 to 7% in 1999, despite the
increased knowledge of modern contraceptive methods
since 1991-92

42. • Education
• Is clearly related to the use of contraceptive method. Only 14% of
women with no formal education are currently using any
contraceptive, compared with 18% of women with incomplete
primary school, 27% of women who have completed primary
school and 43% of women with at least some secondary education

43. • Parity
• Current contraceptive use rises with the number of living children.
The % of women using any contraceptive method rises rapidly
from 7% among women with no living children to 28% among
those with one child and 30% among those with six or more
children

44. • Religion
• Some religions believe in natural methods of
contraception and not modern ones.
• Misconception about FP
• A lot of individuals out there think that FP program is
there to sterilize them.
• Worry over potential side effects
• When expected side effects are not explained carefully
to the client.
• Cultural beliefs
• Some believe that more children will bring more wealth
to their family.

45. • Abortion is illegal in Tanzania (except to save the
mother’s life or health), so women and girls turn to
amateurs, who may dose them with herbs or other
concoctions, pummel their bellies or insert objects
vaginally.
• Infections, bleeding and punctures of the uterus or bowel
can result, and can be fatal. Doctors treating women after
these bungled attempts sometimes have no choice but to
remove the uterus.

46. • Worldwide, there are 19 million unsafe abortions a
year, and they kill 70,000 women (accounting for 13
percent of maternal deaths), mostly in poor countries like
Tanzania where abortion is illegal, according to the World
Health Organization.
• More than two million women a year suffer serious
complications. According to UNICEF, unsafe abortions
cause 4 percent of deaths among pregnant women in
Africa, 6 percent in Asia and 12 percent in Latin America
and the Caribbean.

47. • Keeping abortion outlawed does not actually reduce the
number of abortions; rather, it reduces the safety of those
performed.
• Legal restrictions on abortion do not affect its incidence.
For example, the abortion rate is 29 [per 1,000 women
aged 15–44] in Africa, where abortion is illegal in many
circumstances in most countries, and it is 28 [per 1,000
women aged 15–44] in Europe, where abortion is
generally permitted on broad grounds. The lowest rates
in the world are in Western and Northern Europe, where
abortion is accessible with few restrictions.

48. • Where abortion is legal and permitted on broad grounds,
it is generally safe, and where it is illegal in many
circumstances, it is often unsafe. For example, in South
Africa, the incidence of infection resulting from abortion
decreased by 52% after the abortion law was liberalized
in 1996.
• (ol by american humanist association)published 2012

49. • World Bank, World Development Indicators, November
2010
• National Family Planning Costed Implementation
Program (NFCIP 2010-2015), Ministry of Health and
Social Welfare
• Tanzania Demographic and Health Survey 2010 (TDHS)
Preliminary Report August 2010.
• TDHS 2004-05
• Tanzania family planning landscape
assessment, October 2010